Visceral Metastases as Predictors of Response and Survival Outcomes in Patients of Castration-Resistant Prostate Cancer Treated With Lu-177-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy A Systematic Review and Meta-analysis
CLINICAL NUCLEAR MEDICINE
Authors: Satapathy, Swayamjeet; Mittal, Bhagwant Rai; Sood, Ashwani
Abstract
Background The presence of visceral metastases is associated with poor prognosis in patients of metastatic castration-resistant prostate cancer (mCRPC) treated with hormonal therapy and chemotherapy. However, studies evaluating its impact on treatment outcomes with Lu-177-labeled prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) are currently limited and show inconsistent results. This systematic review was conducted to precisely evaluate the impact of visceral metastases on biochemical response and survival outcomes in patients of mCRPC treated with Lu-177-PSMA RLT. Methods This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Searches in PubMed, Scopus, and EMBASE were made using relevant keywords, and articles up to May 2020 were included. Univariate and multivariate odds ratios and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates were generated using meta-analysis. Results Twelve articles comprising 1504 patients were included in this review. Presence of visceral metastases not only predicted low biochemical response rate (pooled univariate odds ratio: 0.38, 95% confidence interval [CI], 0.22-0.66) but was also a significant prognosticator of worse progression-free survival (pooled univariate HR, 1.85; 95% CI, 1.39-2.46; and pooled multivariate HR, 1.48; 95% CI, 1.15-1.92) and overall survival (pooled univariate HR, 1.77; 95% CI, 1.29-2.44; and pooled multivariate HR, 2.22; 95% CI, 1.82-2.70). There was no evidence of publication bias. Conclusions Presence of visceral metastases was associated with poor response and survival outcomes in patients of mCRPC treated with Lu-177-PSMA RLT. The results are clinically significant for pretreatment risk stratification of such patients and to guide optimal treatment strategies.
Risk Assessments at Birth Predict Kindergarten Achievement and Involvement with Child Protective Services
PREVENTION SCIENCE
Authors: Prendergast, Sarah; MacPhee, David
Abstract
Screening for family risk factors at birth is one way that early childhood programs and practitioners can identify families who might benefit from prevention efforts. Some prevention programs currently use cumulative risk (i.e., total number of risk factors present) to determine eligibility for services. More recently, however, person-centered approaches that take into account combinations of risk (versus cumulative risk) have emerged as an approach that could complement current risk assessment methods and illuminate the extent to which classes of family risk are associated with different outcomes in early childhood. Grounded in ecological theory, we tested cumulative family risk and latent classes of family risk at birth as predictors of kindergarten outcomes and mother-reported involvement with Child Protective Services (CPS). Families in the Fragile Families and Child Well-being Study were included in this study if they had medical records data available at the child's birth as well as children's age 5 kindergarten outcomes (N = 757). Cumulative risk was positively associated with children's attention problems, letter-word recognition skills, CPS involvement, and both covariates (i.e., child's diagnosed disability status and mother's ethnicity/race), but not aggression or social skill problems. In terms of latent classes, children from higher risk classes tended to fare significantly worse on kindergarten outcomes and were more likely to have reported involvement with CPS when compared to the lower risk classes. Implications are discussed related to primary prevention, the merits of screening for risk, and comparisons between cumulative risk and classes of risk approaches.